Hormonal Contraceptive Use and Persistent Staphylococcus aureus Nasal Carriage
Hormonal Contraceptive Use and Persistent Staphylococcus aureus Nasal Carriage
复制标题
DOI：
10.1093/cid/cis778
复制
发表时间：
2012-12-15
影响因子：
11.8
通讯作者：
Kremsner, Peter G.
中科院分区：
文献类型：
--
作者：
Zanger, Philipp;Nurjadi, Dennis;Kremsner, Peter G.
背景。定植有金黄色葡萄球菌的人类鼻孔是这种病原体最重要的储存库。我们研究了性别和激素避孕药的使用对持续性金黄色葡萄球菌鼻腔携带的影响。方法。我们对健康志愿者进行了一项队列研究，并通过使用每个时间点的 2 个拭子样本的结果来确定基线和随访时的携带状态。我们应用逻辑回归来分析感兴趣的关联。结果。在基线时，1180 名志愿者中有 266 名 (22.5%) 被归类为持续性鼻携带者。与不使用激素避孕药的女性相比，服用生殖激素的女性（比值比 [OR]. 1.88；95% 置信区间 [CI]，1.29-2.75；P = .001）和男性（OR.，1.57；95% CI，1.08-2.28；P = .02）更有可能成为持续携带者。在调整已知的鼻腔携带风险因素后，这些关联保持稳定。服用激素避孕药并在基线时为持续携带者的女性在中位随访时间 70 天后比未使用此类药物的女性更有可能继续为携带者（OR，3.25；95% CI，1.44-7.34；P = 0.005）。在女性持续携带和所使用的孕激素类型或雌激素剂量之间没有观察到任何关联模式。假设因果关系并使用多变量逻辑回归的估计，我们估计样本所代表的女性中 20%（95% CI，2.4%-34.9%）的持续鼻腔携带可归因于激素避孕（人口归因分数）。结论。激素避孕的广泛使用可能会大大增加人类金黄色葡萄球菌的储存量，从而对金黄色葡萄球菌的感染和传播产生潜在影响。
Background. Human nares colonized with Staphylococcus aureus are the most important reservoir for this pathogen. We studied the influence of sex and hormonal contraceptive use on persistent S. aureus nasal carriage.Methods. We conducted a cohort study in healthy volunteers and determined carriage status at baseline and again at follow-up by using the results of 2 swab samples at each time point. We applied logistic regression to analyze associations of interest.Results. At baseline, 266 of 1180 volunteers (22.5%) were classified as persistent nasal carriers. Compared with women not using hormonal contraceptives, women taking reproductive hormones (odds ratio [OR]. 1.88; 95% confidence interval [CI], 1.29-2.75; P = .001) and men (OR., 1.57; 95% CI, 1.08-2.28; P = .02) were more likely to be persistent carriers. These associations remained stable after adjusting for known risk factors of nasal carriage. Women taking hormonal contraceptives and being persistent carriers at baseline were more likely to remain carriers after a median follow-up time of 70 days than women not using such medication (OR, 3.25; 95% CI, 1.44-7.34; P = .005). No patterns of association could be observed between persistent carriage among women and type of progestin or dose of estrogen used. Assuming causality and using estimates from multivariable logistic regression, we approximated that 20% (95% CI, 2.4%-34.9%) of persistent nasal carriage among women represented by our sample is attributable to hormonal contraception (population-attributable fraction).Conclusions. The widespread use of hormonal contraception may substantially increase the human S. aureus reservoir with potential impact on S. aureus infection and transmission.